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Long-Term Effects Following an Acute Lateral Ankle

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Long-Term Effects Following an Acute Lateral Ankle LONG-TERM EFFECTS FOLLOWING AN ACUTE LATERAL ANKLE SPRAIN IN A COLLEGE-AGED POPULATION by Bethany A. Wisthoff A dissertation submitted to the Faculty of the University of Delaware in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Biomechanics and Movement Science Spring 2019 © 2019 Bethany A. Wisthoff All Rights Reserved LONG-TERM EFFECTS FOLLOWING AN ACUTE LATERAL ANKLE SPRAIN IN A COLLEGE-AGED POPULATION by Bethany A. Wisthoff Approved: __________________________________________________________ Samuel C.K. Lee, Ph.D. Director of the Biomechanics and Movement Science Program Approved: __________________________________________________________ Kathleen S. Matt, Ph.D. Dean of the College of Health Sciences Approved: __________________________________________________________ Douglas Doren, Ph.D. Interim Vice Provost for Graduate and Professional Education I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Thomas W. Kaminski, Ph.D. Professor in charge of dissertation I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Carrie L. Docherty, Ph.D. Member of dissertation committee I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Joseph J. Glutting, Ph.D. Member of dissertation committee I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Geoffrey P. Gustavsen, MD Member of dissertation committee I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Todd D. Royer, Ph.D. Member of dissertation committee I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Charles B. Swanik, Ph.D. Member of dissertation committee ACKNOWLEDGMENTS First, I would like to thank my advisor and chair of my committee, Dr. Thomas W. Kaminski, for his never-ending support, advisement, and guidance during my doctoral degree experience. I would also like to thank Dr. Carrie L. Docherty, Dr. Joseph J. Glutting, Dr. Geoffrey P. Gustavsen, Dr. Todd D. Royer, and Dr. Charles B. Swanik for their additional support and for serving on my committee. This study would not have been possible without each of their support and feedback during the study design, subject recruitment, data collection and processing, and writing stages. Next, I would like to thank all of my fellow graduate and undergraduate students who have supported me along the way, especially Victoria Wahlquist and Alissa Strouse, who helped during most of my data collections. I would like to thank all of the student volunteers that I had during my data collections. Additionally, I would like to thank my subjects, the students and the student-athletes, who volunteered to participate in my study and continually showed up to the sessions when asked. Without their dedication and participation, I would not have been able to complete this seminal study. Lastly, I would like to thank my family, my parents, David and Susan Johnson, and Robert and Barbara Wisthoff, for their continual love and support throughout this process. To my husband, Dr. Michael Wisthoff, for his patience and continual words of encouragement and support. Finally, to my grandparents, whom I’ve lost along the way, but have been my shining light throughout my entire education and life. v TABLE OF CONTENTS LIST OF TABLES ........................................................................................................ xi LIST OF FIGURES ..................................................................................................... xiii ABSTRACT ................................................................................................................. xv Chapter 1 LATERAL ANKLE SPRAINS: A REVIEW OF LITERATURE ..................... 1 Epidemiology of Lateral Ankle Sprains ............................................................. 1 Anterior Talofibular Ligament Anatomy ........................................................... 6 Ligament Healing ............................................................................................... 9 Injury Classification ......................................................................................... 12 Ankle Joint Laxity ............................................................................................ 15 Techniques for Detecting Joint Laxity in Chronic Ankle Instability- A Literature Review (Submitted to ATSHC) ....................................................... 23 Abstract ....................................................................................................... 23 Background ................................................................................................. 23 Literature .................................................................................................... 26 Stress Ultrasonography ......................................................................... 26 Stress Radiography ............................................................................... 39 Stress MRI ............................................................................................ 40 Cost analysis ..................................................................................................... 42 Arthrokinematic Restrictions ............................................................................ 44 Dynamic Balance Deficits ................................................................................ 47 Chronic Ankle Instability ................................................................................. 49 2 TALOFIBULAR INTERVAL FOLLOWING AN ACUTE LATERAL ANKLE SPRAIN ............................................................................................. 53 Introduction ...................................................................................................... 53 Experimental Design ........................................................................................ 55 Participants ....................................................................................................... 56 Instrumentation ................................................................................................. 57 Procedures ........................................................................................................ 58 Demographic and Anthropometric Data .................................................... 58 vi Injury Classification ................................................................................... 58 Weight-Bearing Lunge Test (WBLT) .......................................................... 59 Dorsiflexion Range-of-Motion (DF ROM) ................................................. 60 Inversion Talofibular Interval (INV TI) ..................................................... 61 Anterior Drawer Talofibular Interval (AD TI) ........................................... 62 Statistical Analysis ........................................................................................... 63 Results .............................................................................................................. 64 Injury Classification and Function ............................................................. 64 AAS Over Time .................................................................................... 64 Group at 6-months ................................................................................ 65 AAS by Severity ................................................................................... 65 AAS Over Time Between Ankles ........................................................ 66 WBLT .......................................................................................................... 66 AAS Over Time .................................................................................... 66 Group at 6-months ................................................................................ 67 AAS by Severity ................................................................................... 67 AAS Over Time Between Ankles ........................................................ 67 DFROM ...................................................................................................... 67 AAS Over Time .................................................................................... 67 Group at 6-months ...............................................................................
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